Application Form for Internship Programme - Aga Khan University

INTERNSHIP
2014
THE AGA KHAN UNIVERSITY
Internship Programme Application Form
Instructions for completing the application:
1. Complete the application form in bold letters or type.
2. The application form should be attested by the Principal of the Institute last worked at or a Professor
in any medical college.
3. All candidates for internship will be required to write an Admission Test. The short-listed candidates
will be interviewed for selection. Only shortlisted candidates will be informed about interview dates
through mail.
4. Application fee and deadlines
- Early bird registration (all programmes): Last Date: Friday July, 19, 2013, 4 pm
Registration Fee: Rs. 2,500/-
- Registration deadline after July 19, , 2013 Thursday August 1, , 2013
(for all programmes) Registration Fee: Rs.5,000/-
- The completed application form along with required documents must be received in the
Medical College Admission Office, Aga Khan University between 9:00 am - 12:00 noon.
Please Note:
- Incomplete application forms will not be processed.
- Awaited documents/final MBBS results and PM&DC Registration should be submitted to the
AKU Medical College Admission Office by December 16, 2013.
- After December 16, 2013, incomplete applications will not be eligible for final selection.
Allocation of rotations to selected interns will be according to the rank order determined by the
MCQ test and interview scores.

INTERNSHIP
2014
THE AGA KHAN UNIVERSITY
Internship Programme Application Form
Date of Application: _________________________
Early Bird † Rs. 2,500/- Regular Registration Rs. 5,000/- †
Registration No.
Following items are to be included with this application:
[ ] Completed application form endorsed by supervisor/principal.
[ ] Attested copies of mark sheets of all professional examinations.
[ ] Attested copy of MBBS degree.
[ ] Attested copy of provisional registration of PMDC.
NOTE: All photocopies should be cut or minimised to A4
[ ] Two passport size photographs: taken one week prior to submission of this application.
1 -
Please leave blank
one attested and pasted on this application form and the other attested at the back for the Admit Card. Face should be clearly visible
[ ] Copy of National Identity Card / Passport (page 1 & 2).
[ ] Self-addressed envelope (4.5 x 8.5 inches).
0
Please paste recent
photograph attested
on the front
(but not on face)
Name
(as per CNIC)
Father/Spouse name
Gender M F Date of Birth Nationality CNIC / Passport #
Mailing Address
Email Cell # Fax #
Permanent Address (if different from mailing address)
Home / Office Tel #
Name of medical college attended
Medical college graduation Month Year
Details of any supplementary exams
Professional Exams
Aggregate Marks
Professional Exams
Aggregate Marks
1st Professional
3rd Professional
2nd Professional
4th Professional
Any other Clinical experience Yes (please provide detail in one line below) No
Admission Test Centre (Select [ ] one) Karachi Hyderabad Rawalpindi
Is your application complete? Yes [ ] No [ ] If no, state pending documents
Endorsement (should be attested by the Principal of the institute last worked at or professor of any medical college)
I certify that the information given above is correct.
Name and Designation
Signature
Official Stamp
Date
Official: Please do not write in this space
Complete [ ] Incomplete [ ]
Received by: ___________________
Dated: __________________________ Recpt#___________________